| NPI | 1548267420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M NICHOLS Executive Director 801-334-2213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: UT 00867511) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-08-22 |